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2019 Baseline Survey Report

Project Name:

Report Date:

Contract Number:

Organization:

Integrated response for drought affected communities in the Central Highlands of Afghanistan

30 November 2019

2DFFP19GR00049

Medair

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Contents 1. Executive Summary ........................................................................................................................... 3

2. Project Overview ............................................................................................................................... 3

3. Methodology ..................................................................................................................................... 4

4. Ethical Considerations ....................................................................................................................... 4

5. Target Population and Sample Size .................................................................................................. 4

6. Sampling Methodology ..................................................................................................................... 5

7. Data Collection, Data Entry, and Data Analysis Tools ....................................................................... 7

8. Survey Limitations ............................................................................................................................. 8

9. Indicators Overview .......................................................................................................................... 8

10. Survey Results ............................................................................................................................... 9

11. Conclusions ................................................................................................................................. 15

12. Annex 1: Indicator Summary Table ............................................................................................. 17

13. Annex 2: Medair Survey Questionnaire ...................................................................................... 20

Acronym Definitions

MUAC Mid Upper Arm Circumference

GAM Global Acute Malnutrition

SAM Severe Acute Malnutrition

PIRS Performance Indicator Reference Sheet

FCS Food Consumption Score

HHS Household Hunger Scale

MDD Minimum Dietary Diversity

IYCFE Infant and Young Child Feeding in Emergencies

ENA Emergency Nutrition Assessment

PPS Probability Proportional to Size

rCSI Reduced Coping Strategy Index

RCs Reserve Clusters

LPD Litres Per Day

ARI Acute Respiratory Infection

KPC Knowledge, Practice and Coverage

PLW Pregnant and Lactating Women

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1. Executive Summary

In July 2019, Medair, through the support of FFP and OFDA, launched an 18-month integrated emergency response project in two provinces of Afghanistan (Daikundi and Bamyan). This project focuses on three districts in Daikundi Province (Khedir, Sharestan, and Miramor) and one district in Bamyan Province (Waras). To capture baseline data for the project indicators, Medair conducted a survey in September 2019 using standard Knowledge, Practice, and Coverage (KPC) methodology with a two-stage cluster-based population sample. The survey used internationally accepted indicators extracted from FFP and OFDA PIRS, Sphere standards, previous Medair KPC surveys, and other household surveys to assess the level of key nutrition, IYCF, WASH, and food security knowledge and practices.

In regards to malnutrition, the prevalence of global acute malnutrition (GAM) among children aged 6-59 months was 10.1% (as measured by MUAC). The prevalence of severe acute malnutrition (SAM) in this age group was 2.6% (also measured by MUAC). The GAM rate was particularly high among pregnant and lactating women (PLW) at 31.7%. Child morbidity levels are also high, with caregivers reporting that 63.5% of children were sick in the previous two weeks. Rates of early and exclusive breastfeeding were unusually positive, at 67.1% and 92.4%, respectively.

Most families have poor dietary diversity, most likely due to the lack of available food. Food consumption analysis indicates that 69.9% of families have poor food consumption levels. Only 2.3% of children aged 6-23 months are regularly consuming four or more food groups each day. 83.9% of respondents reported that their household is using at least 2 coping strategies, and households are using three coping strategies, weekly, on average. In contrast, 74.0% of respondents had low perception of household hunger rankings in the past month, which may indicate consumption of nutritionally poor but filling foods.

Hygiene knowledge and practices were weak, with only 22.6% of respondents able to list three critical handwashing times. Just 16.5% of respondents reported to have washed their hands with soap at a minimum of three critical times in the previous day.

Water quality is poor, with only 27.4% of households collecting water from a safe source. Average daily water consumption is 14.1 litres per day with only 17.1% of households observed to practice safe water storage. Use of improved sanitation facilities is rare with 10.2% of households using an improved facility and 45.7% of households reporting practicing open defecation.

2. Project Overview

After a prolonged dry spell and subsequent drought, much of Afghanistan’s Central Highlands region is experiencing Crisis and Emergency levels of food insecurity. High levels of malnutrition, a lack of access to safe drinking water, and a failed harvest in 2018 meant that urgent action was needed to reduce mortality and morbidity amongst vulnerable groups.

Building on Medair’s seventeen years of experience in the Central Highlands, Medair proposed to work in Bamyan and Daikundi Provinces with mothers, pregnant and lactating women (PLW), newborns, and children under five, with the goal of improving nutrition levels, reduce family vulnerability to water-related and other preventable diseases, and increasing economic access to food resources in local markets. In an effort to achieve greater sustainability through this emergency project, Medair teams expanded their traditional curative nutrition programming to include kitchen gardening, cash transfers for food, and cash-for-work to increase food security of drought-affected households. Although this is an emergency project, behaviour change communication is included within all proposed sectors as well to ensure greater durability of proposed family and community-level changes.

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3. Methodology

This survey was conducted to evaluate project baselines by measuring key nutrition, IYCF, food security, and WASH indicators related to project activities. The survey included questions related to child morbidity, nutritional status, IYCF practices, access to and use of water and sanitation infrastructure, key hygiene practices for disease prevention, dietary diversity, the Household Hunger Scale (HHS), Food Consumption Score (FCS), and preferences for beneficiary feedback.

The indicators measured through the baseline survey were selected to allow for evaluation of the project objectives and impact, and were focused on the planned project response. Several additional indicators were included to reflect the overall baseline conditions for families in the project areas. The survey collected primary source information as it was a combination of questions and observations collected from house to house.

Survey Area, Design and Data Sources: the project baseline survey was conducted using standard KPC assessment indicators and data collection tools. Data was collected from three targeted districts (Khedir, Sharestan, and Miramor) in Daikundi province and one targeted district (Waras) in Bamyan. The target communities in the survey area were the general community residing in the project catchment. This included primary care givers of children less than five years of age (for child morbidity, WASH, and food security assessment); primary care givers of children between 0 and 23 months of age (for IYCF assessment); and children between 6 and 59 months and PLWs (for MUAC).

4. Ethical Considerations

Medair notified the provincial public health office before starting the survey and obtained verbal consent from each survey participant. The participants were briefed about the objectives and importance of the study before starting the interview. All interviews were conducted in areas where the privacy of the participants was maintained. Prior to initiating the interview, the purpose of the study, manner of the questioning, and confidentiality assurance was verbally communicated to the participants. They were informed of having full rights to participate or not to participate in the study as well as to withdraw at any time during the interview. Those children and mothers identified as malnourished were advised to visit appropriate health facilities for proper care.

5. Target Population and Sample Size

The survey employed a sample size calculation formula and assumptions in order to generate comparable data against the planned future endline KPC survey and measure progress of the intervention related to project indicators.

Sample sizes were decided on taking into consideration the respective denominators per required indicator, to ensure that 95% confidence levels with 5% margins of error could be calculated. A design effect of 2 was used to take into account the two-stage cluster sampling frame, and assumed an infinite population.

n=deff* Zα2 pq / d2

n= the number of children to be sampled for the survey deff= design effect =1.5 for malnutrition, or 2.0 for other variables (indicators)

Zα = the critical value for 95% confidence (Zα=1.96) d= the required precision=0.05

p= Proportion of the target population with the characteristics being measured q= 1-p

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The sample size is estimated for each indicator in Table 1.

Table 1. Estimated Sample Size for each variable (indicator)

However, given the excessively large sample size required for most indicators, Medair opted to balance precision and efficiency. In analysing the indicator requirements, sample size and time requirements, Medair technical advisors confirmed that a sample size of 467 households would provide sufficient precision for this non-academic survey.

6. Sampling Methodology

A two-stage cluster sampling with probability proportionate to size (PPS) design was employed. The Emergency Nutrition Assessment (ENA) software was used to randomly select clusters, including additional Reserve Clusters to be available as needed.

Selection of Clusters

Random selection of clusters/villages was done using ENA for SMART software version 2011. Lists of all secure villages were loaded into ENA software and PPS was applied. Reserve Clusters (RCs) were also selected by the software. In each selected village, one or more community member(s) were asked to help the survey teams to conduct their work by providing information about the village with regard to the geographical organization, security, and the number of households. It was estimated that one team could cover 10 households per day. To reach the targeted number of households, 47 clusters were selected. Out of 390 total villages in the catchment population, 47 villages, corresponding to 47 clusters, were selected for the survey from the sampling frame.

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Selection of HHs and Children

The survey teams implemented a simple random sampling approach in collaboration with the community leader. With that leader, the survey team supervisor confirmed the number of households in the community and then divided the number by 10 (the desired cluster sample size). Based on this figure, the supervisor implemented a skip pattern, and worked with the community leader to ensure that they counted all households in the community. Where the community was not large enough to have enough houses for a full sampling, the teams were instructed to go to the next nearest community to complete their cluster.

The household was the basic sampling unit. All of the selected households were included for WASH and food security assessments.

Children aged 0-59 months were targeted for child morbidity indicators. If more than one eligible child was found in a household, then the survey teams randomly selected one child, using a random sample table.

Children aged 6-59 months were targeted for nutrition indicators. All children in the household within this age range were considered for the survey. Eligible orphans living in the selected households were also surveyed.

Children aged 0-23 months were targeted for the IYCF indicators. If more than one eligible child was found in a household, the youngest one was considered for the survey (including twins). Eligible orphans living in the selected households were also surveyed. For exclusive and early breastfeeding indicators, this data was filtered for children aged 0-5 months.

Any empty households were revisited at the end of the sampling day in each cluster and a cluster control form used to record all these missed and absent households.

Case definitions, indicators and inclusion criteria

A household, as the basic sampling unit, was defined as individuals who usually eat from the same pot and sleep under one roof, and does not necessarily include biological relatives (WFP definition). This household definition was used to determine the number of households in a polygamous family or in a compound setting. If a polygamous family or a compound contained multiple groups of people eating from different pots and sleeping under separate roofs, then they were considered as separate households for selection purposes.

Core Indicators and operational definitions

The following key indicators were assessed. Survey results for these key indicators are presented with confidence intervals.

Childhood nutrition: Proportion of children aged 6-59 months suffering from malnutrition, as measured with the MUAC (Mid Upper Arm Circumference) method. Measured for two levels of malnutrition: Global Acute Malnutrition (GAM) with MUAC

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Water storage: Proportion of households observed to have clean and covered drinking water storage containers.

Water consumption: Amount of water used in the household in the last 24 hours to assess the water consumption per person per day.

Agricultural practices: Proportion of households with access to vegetables seeds to plant.

Food Consumption Score (FCS): Proportion of households with poor, borderline, and adequate food consumption score.

Household Hunger Scale (HHS): Prevalence of households with moderate or severe Household Hunger Scale (HHS) score.

Coping Strategy Index (rCSI): used as a proxy indicator of household food insecurity based on a list of behaviors (coping strategies) combining the frequency of each strategy (how many times each strategy was adopted per week) and severity.

Other indicators related to child morbidity, IYCF, PLW nutrition status, WASH, sanitation facilities, and beneficiary feedback were also assessed in order to highlight needs in the communities and inform project implementation. The survey results of these indicators are also presented in this report, but without confidence interval analysis. Target Population and geographical scope: The survey covered Sharestan, Miramor, and Khedir Districts of Daikundi province and Waras District in Bamyan province.

Survey dates: the baseline data was collected between 21st September and 2nd October 2019, which included travel days and days off during the national election period.

7. Data Collection, Data Entry, and Data Analysis Tools

Data collection tools: A paper form was used in the field. The questionnaire was translated into the local language (Dari) by professionals and double checked and tested in the area for quality assurance.

Team composition: Data was collected in 47 clusters through nine teams. Each team was composed of a male team supervisor and two female enumerators. The survey manager recruited these team members based on recommendations from DoPH and from another NGO that had completed a similar survey immediately before this baseline survey.

Training: A four day training (including one day of field study) was conducted to ensure enumerator understanding and the quality of data collected. The survey manager facilitated the training with support from other Medair colleagues. Topics included: introduction to survey tools, common situations, questions and errors in data collection, sampling procedures, and questionnaire review.

Data collection: Data was collected over six days from 47 clusters. The questionnaire with consent form, cluster control form, random selection table, event calendar, and training sheets were prepared and provided to field teams.

Supervision and Quality Assurance: o Data collection was monitored by the survey leader and three Medair team members.

Survey sites were often very remote, so teams spent the night in the field. This meant that the survey leader and Medair team members monitored one team each day, and were not able to monitor every team each day.

o Daily feedback was provided to the team in regard to the quality of data collected and missing values at field level by the survey leader and monitors.

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Data entry: data was entered at the end of the survey period and was verified by a Quality Assurance team member.

Analysis: A specialized excel sheet created by Medair was used for estimation of prevalence, design effect and confidence interval for each indicator.

8. Survey Limitations

A compromise in sample size results in suboptimal precision; especially for Early Breastfeeding and Minimum Dietary Diversity, this resulted in wide confidence intervals.

The cross-sectional nature of the data used for this survey makes it difficult to elucidate causality among variables.

As most of the questions asked were about events that happened in the past, the study may be vulnerable to recall bias.

Population figures provided by local government did not match the numbers observed in villages in the field.

Possible Bias

Selection bias: The survey leaders trained the teams to use randomization techniques to minimize selection bias; even so some bias may exist.

Translation bias: Interpretation of questions may be different in Dari compared to the original question written in English. Accordingly, Medair hired a translation professional to complete the translation, and also confirmed and tested the translation with Medair colleagues. During the training session, the survey team took sufficient time to translate the questionnaire and training materials into Dari. Surveyors were able to easily view the text in Dari and English in the data collection tools.

Investigator bias: The opinions of the surveyors and their supervisors may skew results. For example, surveyors may show verbal or non-verbal responses to what is “correct” during the interview. The team worked to minimize this bias during training through role playing.

Respondent bias: Respondents may have an interest in providing incorrect answers because they think that they may benefit later, especially in the event that their responses lead to support from donors. In each household, the surveyors explained the objectives of the study to reduce this bias.

To reduce the risks of bias, the survey manager selected educated surveyors who were able to follow instructions, explained the rationale for the survey and the importance of collecting accurate information, and facilitated the training for the surveyors to ensure they had thoroughly practised the survey.

9. Indicators Overview

A total number of 492 households participated in this baseline survey. Mothers and primary care takers responded to the survey questionnaire. Detailed analysis is included in Annex 1.

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The key indicators and the associated target population are presented here.

Key indicators Survey target group

GAM rate by MUAC 6-59 months

Exclusive Breast Feeding 0-5 months

Morbidity (ARI/Diarrhea/Fever) 0-59 months

MDD (Minimum Dietary Diversity) Score >4 6-23 months

HH dietary diversity Households

% people who know 3 of the 5 critical handwashing times Households

Store drinking water safely in clean containers Households

Average litres/person/day collected Households

% households with poor-to-adequate FCS Households

% households with sufficient vegetables seeds Households

Moderate or severe Household Hunger Scale (HHS) score Households

Prevalence of coping strategies Households

10. Survey Results

Nutrition Indicators: A total of 10.1% (7.6%-12.5%, 95% C.I.) of children were identified as suffering from acute malnutrition, as measured with a MUAC of less than 12.5cm. 2.6% (1.3%-3.8%, 95% C.I.) of children were identified as suffering from severe acute malnutrition (SAM), as measured with a MUAC of less than 11.5cm. The surveyors counselled the families of SAM children to take the child to the appropriate health facility for care.

For pregnant and lactating women (PLW), the numbers were much higher, with 31.7% (21.8%-41.6%, 95% C.I.) identified as acutely malnourished, as measured with a MUAC of less than 23cm. This may indicate that there is a coping strategy where families give food to children in preference to the mothers when food is scarce.

Acute Malnutrition Status Total 95% C.I.

GAM rate for children aged 6-59 months 10.1% ± 2.5%

SAM rate for children aged 6-59 months 2.6% ± 1.3%

GAM rate for PLW 31.7% ± 9.9%

IYCF Indicators: As per the WHO’s recommendations, all children in developing countries must be breastfed, and the survey results highlight this to be predominately true in the Central Highlands. In the project catchment area, among survey households with children less than six months old, 92.4% (76.7%-100%, 95% C.I.) of mothers reported that they exclusively breastfed their infants until they reached six months of age. The questionnaire also inquired about early initiation of breastfeeding, which evaluates whether the mother breastfeeds the infant within one hour of birth. This indicator had relatively strong results, with 67.1% (51.5%-82.7%, 95% C.I.) of mothers indicating that they breastfed their child within one hour of birth. The MDD indicator measures whether children aged 6-23 months receive food from four or more food groups. Very low rates of children at 1.2% (0%-3.1%, 95% C.I.) were reported to have received the minimum dietary diversity within the past day. The most common food group was cereals/grains, with all other food groups only reported by less than 16% of respondents. This is similar to other baseline results from similar regions. Due to the relatively small sample size of this target age

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group, there were no statistically significant differences detected in the IYCF practices provided to male or female children.

IYCF Indicators Total 95% C.I.

Exclusive Breastfeeding 92.4% ± 15.8%

Early Breastfeeding 67.1% ± 15.6%

Minimum Dietary Diversity 1.2% ± 2.0%

Child Morbidity: As shown in the table below, the survey indicates that 63.5% (55.5%-71.6%, 95% C.I.) of surveyed children were reported to be sick in the previous two weeks. The most commonly reported illness was febrile illness at 50.9% (43.6%-58.3%, 95% C.I.), followed by diarrheal illnesses at 39.9% (33.5%-46.4%, 95% C.I.), and coughing/ARI at 28.3% (22.6%-34.0%, 95% C.I.).

The survey also indicates that 60.3% (50.9%-69.6%, 95% C.I.) of households with a sick child sought treatment from an appropriate care provider, and 42.9% (33.6-52.2%, 95% C.I.) reached the facilities within 48 hours after the onset of the symptoms. The survey also assessed the maternal knowledge of danger signs for childhood illnesses, finding that 75.0% of respondents effectively identified two or more danger signs of childhood illness.

Child Morbidity in previous two weeks Results 95% C.I.

Any illness 63.5% ± 8.1%

Fever 50.9% ± 7.4%

Diarrhea 39.9% ± 6.5%

Coughing/ARI 28.3% ± 5.7%

Health Seeking Behaviour

Sick child: sought care from appropriate provider 60.3% ± 9.3%

Sick child: sought care from appropriate provider within 48 hours 42.9% ± 9.3%

Food Security Indicators

Food security was evaluated using several standard indicators:

Food Consumption Score: The FCS is a composite score based on dietary diversity, food frequency, and relative nutritional importance of different food groups, that has a reference period of seven days. Due to high reliance on oil and sugar, Medair used the WFP adapted scale for this context which indicates an FCS 42 as having “acceptable” food consumption.

Household Hunger Scale: the HHS is a perception-based indicator to evaluate the experience of food deprivation using questions specific to having no food, going to sleep hungry and/or going a whole day and night without eating, as well as the frequency of these events in the past month. The results are classified into 3 categories: little to no hunger, moderate hunger and severe hunger in the household.

32.9% (27.8%-38.0%, 95% C.I.) of respondents reported growing fruit or vegetables near their homes for household consumption in the past year. This indicates some access to vegetables and seeds, however the overall dietary diversity of the households would suggest limited production and/or variety.

Only 5.7% (3.2%-8.2%, 95% C.I.) of respondents have an acceptable food consumption score (FCS), and 24.4% (19.7%-29.0%, 95% C.I.) have a borderline FCS. A total of 69.9% (65.0%-74.9%, 95% C.I.) of

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respondents have a poor food consumption score, which indicates inadequate food diversity and food security that can impact morbidity, especially in children.

Despite poor FCS scores, the HHS indicates that there are relatively limited experiences of lack of any food in the household, leading to moderate or severe HHS classification. This suggests that people have food to eat (typically staples), although the dietary diversity and overall FCS is poor. This is also corroborated by the food groups reported for MDD in children 6-23 months. According to the HHS, 74.0% (69.2%-78.7%, 95% C.I.) of households experience little hunger, 14.8% (11.0%-18.7%, 95% C.I.) experience moderate hunger, and 11.2% (7.8%-14.6%, 95% C.I.) of households experience severe hunger.

Food Consumption Score Results 95% C.I.

Poor FCS (less than 28) 69.9% ± 5.0%

Borderline FCS (28-42) 24.4% ± 4.6%

Acceptable FCS (more than 42) 5.7% ± 2.5%

Household Hunger Scale

Little hunger (0-1) 74.0% ± 4.7%

Moderate hunger (2-3) 14.8% ± 3.8%

Severe hunger (4-6) 11.2% ± 3.4%

Coping Strategies: The rCSI indicator was partially measured and provides interesting information but is lacking in the frequency/severity measures and therefore cannot be adequately analysed in this baseline. Even so, results show that 83.9% (80.0%-87.9%, 95% C.I.) of respondents are using at least 2 coping strategies. These strategies include:

Relying on less preferred food and less expensive food

Borrowing food, or relying on help from friends and relatives

Restricting consumption by adults in order for small children to eat

Limiting portion size at mealtimes

Reducing the number of meals eaten in a day

Sending children to work for money outside the home

On average, respondents are using three coping strategies to deal with a lack of food availability. 83.9% of respondents are borrowing food or asking family and friends for help, while 82.2% are relying on less preferred and less expensive foods. More than 50% of respondents have adults who are restricting their food consumption so that the small children have enough food. Families are also reducing the number of meals, limiting portion size, and resorting to child labour at lower, but still notable rates.

Nearly 75% of respondents reported that family members were equally affected by the coping strategies.

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Coping Strategies Results

Using at least 2 coping strategies 83.9%

Average number of coping strategies per respondent 3

Coping Strategies

Borrowed food or relied on help from friends and relatives 83.9%

Relied on less preferred food and less expensive food 82.2%

Restricted consumption by adults in order for small children to eat 51.0%

Reduced the number of meals eaten in a day 24.1%

Limited portion size at mealtimes 23.9%

Sent children to work for money outside the home 18.8%

Coping Strategies equally affect all family members 74.2%

WASH Indicators: Inadequate drinking water, sanitation and hygiene (WASH) are important risk factors and significant contributors to disease and malnutrition.

Only 27.4% (22.6%-32.3%, 95% C.I.) of households report using safe drinking water sources, such as protected springs, handpumps, and tapstands.

Key Indicators: Water Results 95% C.I.

Households using safe drinking water sources 27.4% ± 4.8%

Households with water source within 30 minutes collection time 88.0% ± 3.5%

Households with safe water source within 30 minutes collection time 24.8% -

Water Collection Time

< 15 minutes 62.4%

15 - 30 minutes 25.6%

30 - 60 minutes 8.9%

1 - 2 hours 2.8%

> 2 hours 0.2%

Water Accessibility: The survey also assessed accessibility of the water sources by evaluating the typical time taken for collection. A total of 88% of respondents are able to travel to the water source, collect water and return to their homes within 30 minutes. Nearly all (96.9%) respondents are able to collect drinking water in less than one hour.

Water Quality: Unprotected springs were the most common source of water (47.2%). Other common water sources were surface water (16.3%), unprotected wells (11.8%), tapstands (11.0%), protected springs (9.8%), and hand pumps (8.3%). Note that households may have more than one water source.

Water Source Results

Unprotected Spring 47.2%

Surface Water 16.3%

Unprotected Well 11.8%

Tapstand 11.0%

Protected Spring 9.8%

Handpump 8.3%

Tanker 0.4%

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Water Storage: Most respondents did not have appropriate water storage. Only 17.1% of respondents had clean and covered water containers. Clean and covered water containers are an important component of safe water handling from the source to the point of consumption. In addition, the need for distribution of water containers is clear with enumerators reporting that many water storage containers were in poor condition and deteriorated.

Water Storage Containers Results

Clean 26.4%

Covered 47.0%

Clean and covered 17.1%

No water storage containers 1.8%

Water Quantity: The quantity of water used per person in the household (for cooking, cleaning, washing and drinking) was evaluated against emergency and target standard levels. The total average litres per day (Lpd) was 14.1, with the majority of households, 88.4% (85.0%-91.9%, 95% C.I.), using at least the minimum emergency level of 7.5 Lpd. However, only 38.6% (33.3%-43.9%, 95% C.I.) of respondents reported collecting sufficient water on a daily basis to meet the target standard levels of 15 Lpd. It is important to note that specific household size was not available in the survey so the Lpd were calculated using assumed average household sizes; future surveys will ensure that the Lpd is calculated on a house-by-house basis for a more accurate result.

Daily Water Collection Results 95% C.I.

At least 7.5l per person per day (emergency levels) 88.4% ± 3.5%

At least 15l per person per day (target standard) 38.6% ± 5.3%

Average daily consumption per person 14.1 litres -

Sanitation: Enumerators observed the sanitation facilities used for each household. These were classified according to the typical structures present. Improved latrines include facilities with a sealed vault, ventilation and a slab; unimproved facilities include latrines where the pit or vault is not sealed and there is no ventilation pipe (common traditional style); basic latrines include a simple superstructure over a shallow pit that is uncovered), as well as methods such as dig/bury and open defecation.

Limited coverage of improved latrines was observed (10%), with a higher proportion of households using the traditional unimproved latrines (40%). Although this style of latrine provides some level of waste management, it still allows for significant disease transmission and exposure and may not improve morbidity related to sanitation practices. Many households also reported practicing open defecation.

Sanitation Facilities Results

Open defecation 45.7%

Unimproved latrine 40.0%

Improved latrine 10.2%

Basic Latrine 5.1%

Dig and bury 1.0%

Handwashing knowledge and practice: One of the most important hygiene behaviors is handwashing. Only 16.5% (12.4%-20.5%, 95% C.I.) of respondents reported washing hands with soap at three critical times in the previous 24 hours. The limited handwashing practices were corroborated by observations,

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with only 5.7% (3.2%-8.2%, 95% C.I.) of households observed to have a specific location in or near the home supplied with soap and water.

The respondents’ knowledge of critical handwashing times is slightly higher than is commonly practiced, however still very low with only 22.6% (18.0%-27.1%, 95% C.I.) of respondents able to cite at least three critical times to wash hands. On average, respondents could only list one critical handwashing time.

Handwashing Knowledge and Practice Results 95% C.I.

Reported handwashing with soap at 3 critical times in previous 24 hours 16.5% ± 4.0%

Able to cite 3 critical times to wash hands with soap 22.6% ± 4.5%

Average: knowledge of critical handwashing times 1 -

Households with functional handwashing facility 5.7% ± 2.5%

While the respondents reported that levels of handwashing with soap are quite low, it is encouraging to see that the most frequently reported handwashing time with soap is after defecation (39%), one of the most important critical handwashing times. Note that respondents were able to select more than one answer.

Handwashing Practice Results

After defecation 39.0%

After cleaning a child's defecation 33.7%

Before cooking 23.8%

Before eating 17.5%

Before breastfeeding or feeding a child 8.9%

Knowledge of critical handwashing times was also quite low, with similar results to the handwashing practices - handwashing after defecation was the most commonly cited critical time.

Handwashing Knowledge Results

After defecation 42.7%

After cleaning a child's defecation 32.9%

Before eating 29.5%

Before cooking 27.4%

Before breastfeeding or feeding a child 12.8%

Beneficiary Feedback: Most respondents (70.9%) strongly preferred to give feedback (good or bad) to aid agencies about the assistance they were receiving in their own home. 25.6% said that they would prefer a phone call and 18.1% preferred to give feedback face to face, but with the presence of a community member. It is important to note that the respondent is the female caregiver, and that they are generally most comfortable in the home setting. They also have little experience interacting with aid workers. Respondents were able to select more than one answer.

Similarly, most respondents (57.1%) preferred to give feedback regarding bad behaviour or misconduct to aid agencies in their own home. 35.2% said that they would prefer a phone call and 22.8% preferred to give feedback face to face, but with the presence of a community member.

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Feedback on Aid Results

Face to face (at home) with aid worker 70.9%

Phone call 25.6%

Face to face with member of the community 18.1%

Face to face (office/other venue) with aid worker 7.1%

Complaints/Suggestions box 1.0%

SMS 0.4%

Letter 0.2%

Email 0.0%

Don't know 4.5%

Feedback on Misconduct/Bad Behaviour

Face to face (at home) with aid worker 57.1%

Phone call 35.2%

Face to face with member of the community 22.8%

Face to face (office/other venue) with aid worker 7.5%

Complaints/Suggestions box 1.4%

SMS 0.8%

Letter 0.6%

Email 0.0%

Don't know 5.5%

11. Conclusions

Although the overall situation for Daikundi families seems to have improved in the past year, with relatively higher precipitation levels and greater access to services, results of this brief baseline reflect households still facing many aggravating health and food security risks resulting in concerning levels of malnutrition, morbidity, and hygiene. This survey identified a number of needs and complementary opportunities, which should positively improve from a successful multi-sectoral intervention to assist in the strengthening and recovery of community resilience.

This baseline shows a measured malnutrition GAM rate of 10.1%, indicating a serious level of food security, comparable to results from a recent SMART survey conducted in the province. In addition, over 30% of pregnant and lactating women are also malnourished while 26.0% of households report moderate to severe hunger levels, with high rates (70%) of poor FCS being present. In a disaster-prone environment, the importance of building family and community resilience against malnutrition through integrated community programs to improve coping strategies is a sound solution. Furthermore, 64% of children were ill in the weeks before this baseline. The high morbidity levels in malnourished children under five highlights a great need for accessible primary health care services, particularly for the malnourished - those who are the immediate victims in this post-drought scenario.

Although major IYCF practices can have commendable impact on health, these alone are insufficient to protect growing children, particularly during disasters. Complementary feeding, in particular, requires a concerted effort to sustainably address nutrition needs over a child’s first 5 years. This is especially true when cyclical harvest seasons regularly increase and diminish food security levels over the year. Medair’s integrated high quality nutrition program, integrated with cash for food, and kitchen garden activities, should positively impact the areas’ nutrition status and recovery - also increasing the longer term resilience of the communities served.

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Improved water quality and availability through protection of springs and provision of hand pumps will result in a life-saving impact on these communities. The baseline shows that poor hygiene practices are prevalent in the catchment area, particularly in handwashing, safe water storage, and sanitation practices. These represent significant areas for improvement which will in turn reduce child morbidity and increase nutritional status, while furthering the resilience of communities

This report confirms the prevalence of highly vulnerable families in Medair’s intervention area, despite the post-harvest timing of the assessment. Future shock, resulting from natural disaster and/or winter morbidity risks, could quickly lead to devastating outcomes. Even without another acute crisis, the coming winter - with limited health care access, reduced food sources, and limited heating - will be difficult and it is expected that the nutrition situation will have deteriorated considerably by the spring.

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12. Annex 1: Indicator Summary Table

Indicators Results 95% C.I.

Malnutrition

GAM rate for children aged 6-59 months 10.1% ± 2.5%

SAM rate for children aged 6-59 months 2.6% ± 1.3%

GAM rate for PLW 31.7% ± 9.9%

IYCF

Exclusive Breastfeeding 92.4% ± 15.8%

Early Breastfeeding 67.1% ± 15.6%

Minimum Dietary Diversity 1.2% ± 2.0%

Child Morbidity in previous two weeks

Any illness 63.5% ± 8.1%

Fever 50.9% ± 7.4%

Diarrhea 39.9% ± 6.5%

Coughing/ARI 28.3% ± 5.7%

Health Seeking Behaviour

Sick child: sought care from appropriate provider 60.3% 9.3%

Sick child: sought care from appropriate provider within 48 hours 42.9% 9.3%

Caregivers who can site two or more danger signs related to childhood illness 75.0% -

Food Security

Households growing fruit/vegetables for personal consumption 32.9% -

Food Consumption Score

Poor FCS (less than 28) 69.9% ± 5.0%

Borderline FCS (28-42) 24.4% ± 4.6%

Acceptable FCS (more than 42) 5.7% ± 2.5%

Household Hunger Scale

Little hunger (0-1) 74.0% ± 4.7%

Moderate hunger (2-3) 14.8% ± 3.8%

Severe hunger (4-6) 11.2% ± 3.4%

Coping Strategies

Using at least 2 coping strategies 83.9% ± 4.0%

Average number of coping strategies per respondent 3 -

Borrowed food or relied on help from friends and relatives 83.9% -

Relied on less preferred food and less expensive food 82.2% -

Restricted consumption by adults in order for small children to eat 51.0% -

Reduced the number of meals eaten in a day 24.1% -

Limited portion size at mealtimes 23.9% -

Sent children to work for money outside the home 18.8% -

Coping Strategies equally affect all family members 74.2% -

Water Sources

Households using safe drinking water sources 27.4% ± 4.8%

Households with water source within 30 minutes collection time 88.0% ± 3.5%

Households with safe water source within 30 minutes collection time 24.8% -

Daily Water Consumption

At least 7.5l per person per day (emergency levels) 88.4% ± 3.5%

At least 15l per person per day (target standard) 38.6% ± 5.3%

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Average daily water consumption per person (Lpd) 14.1 litres -

Water Source Type

Unprotected Spring 47.2% -

Surface Water 16.3% -

Unprotected Well 11.8% -

Tapstand 11.0% -

Protected Spring 9.8% -

Handpump 8.3% -

Tanker 0.4% -

Water Collection Time

< 15 minutes 62.4% -

15 - 30 minutes 25.6% -

30 - 60 minutes 8.9% -

1 - 2 hours 2.8% -

> 2 hours 0.2% -

Water Storage Containers

Clean 26.4%

Covered 47.0%

Households observed to practice safe water storage (clean and covered) 17.1% ± 4.1%

No water storage containers 1.8% -

Sanitation Facilities

Open defecation 45.7% -

Unimproved latrine 40.0% -

Improved latrine 10.2% -

Basic Latrine 5.1% -

Dig and bury 1.0% -

Handwashing Practice and Knowledge

Respondents who can cite at least 3 critical times for handwashing 22.6% ± 4.5%

Number of critical handwashing times mentioned (average) 1

Respondents who report having used soap for washing hands at least 3 critical times during the last 24 hours

16.5% ± 4.0%

Households with functional hand washing facility (specific place with water & soap)

5.7% ± 2.5%

Handwashing Practices

After defecation 39.0% -

After cleaning a child's defecation 33.7% -

Before cooking 23.8% -

Before eating 17.5% -

Before breastfeeding or feeding a child 8.9% -

Knowledge of Handwashing Practices

After defecation 42.7% -

After cleaning a child's defecation 32.9% -

Before eating 29.5% -

Before cooking 27.4% -

Before breastfeeding or feeding a child 12.8% -

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Beneficiary Feedback on Aid

Face to face (at home) with aid worker 70.9% -

Phone call 25.6% -

Face to face with member of the community 18.1% -

Face to face (office/other venue) with aid worker 7.1% -

Complaints/Suggestions box 1.0% -

SMS 0.4% -

Letter 0.2% -

Email 0.0% -

Don't know 4.5% -

Beneficiary Feedback on Misconduct/Bad Behaviour

Face to face (at home) with aid worker 57.1% -

Phone call 35.2% -

Face to face with member of the community 22.8% -

Face to face (office/other venue) with aid worker 7.5% -

Complaints/Suggestions box 1.4% -

SMS 0.8% -

Letter 0.6% -

Email 0.0% -

Don't know 5.5% -

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13. Annex 2: Medair Survey Questionnaire AFG191 Integrated Emergency Response Project: Baseline Assessment

Consent

Hello. My name is _________________________________. I am working with a non-government organization called Medair and we are doing an assessment in your community. The information we collect will help Medair staff to design programs to serve your community. Your family was selected for the assessment. Do you have time now for me to tell you about it? (If not now, ask for a time when we can return.) These questions usually take about 30 minutes. I will collect the answers on this tablet. All of the answers you give will be confidential and will not be shared with anyone other than members of our assessment team. You don't have to be in our assessment and there is no payment for participating, but we hope you will agree to answer the questions since your experience is important. If you don’t want to participate, there will be no bad results for your household. If you do participate in the assessment and I ask you any questions you don't want to answer, just let me know and I will go on to the next question. You can also stop the interview at any time.

Are you willing to participate in this survey? ☐ Yes ☐ No سالم نام ____________است

شما یک ارزیابی را انجام میدهیم. معلوماتی را که جمع می کنیم منطقهمن در یک سازمان غیر دولتی بنام میدیر کار میکنم ما در

شما پروگرام هایی را تهیه کنند. خانواده شما برای این ارزیابی انتخاب منطقهکارمندان میدیر را کمک میکند تا برای خدمت به

فعآل وقت ندارد، بپرسید که چه وقت میتوانید دوباره شده است آیا فعال شما وقت دارید تا در این باره با هم گپ بزنیم ؟ )اگر

.بیایید(

دقیقه وقت را خواهد گرفت و من جوابها را در این تابلیت جمع آوری خواهم کرد. تمام جوابهای را که شما ۳۰این سواالت در حدود

شد . میدهید محرم است و با هیچ کسی دیگر به غیر از اعضای تیم ما شریک نخواهد

شما مجبور نیستید که در ارزیابی ما شامل شوید برای اشتراک در این سروی برای شما پول داده نخواهد شد اما چون تجربه شما

برای ما مهم است امید واریم که سوال های ما را جواب دهید . اگر شما اشتراک نمی کنید این کار کدام عواقب خراب برای خانواده

اهد داشت اگر اشتراک کردید و در جریان مصاحبه کدام سوال را نمی خواستید جواب دهید مرا بگویید من به سوال بعدی شما نخو

خواهم رفت شما میتوانید در هر زمان مصاحبه را خاتمه دهید.

آیا میخواهید در این سروی اشتراک کنید؟ ☐ Yes بلی ☐ No خیرن

1. Location Information معلومات موقعیت

1a) Enumerator Name ______________________________ اسم سروی کننده

1b) Survey Date (dd/mm/yy) ______________________________ تاریخ سروی

1c) Province والیت Bamyan بامیان Daikundi دایکندی

1d) District ولسوالی Miramor میرامور

Sharestan شهرستان

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Khedir خدیر Ashtarlai اشترلی Legan لیگان

1e) CDC ______________________________ شورای انکشافی جامعه

1f) Village ______________________________ قریه

1g) Sample ID number ______________________________ شماره آی دی )هویت( نمونه

1h) Head of Household Name ______________________________ نام سرپرست خانواده

1i) How do you describe your household type? وضعیت فامیل شما چه قسم است؟

Host/Permanent Resident خانه/ باشنده دایمیصاحب IDP بیجا شده گان داخلی Refugee مهاجر New returnee (less than 6 months) ماه( ۶بازگشت کننده جدید ) کمتر از Old returnee (older than 6 months) ماه( ۶بازگشت کننده سابقه ) زیادتر از

2. Child Morbidity حالت مریضی

طفل2a) (Enumerator: Please randomly select one child who is aged 0-59 months.)

ماه است انتخاب کنید. ۵۹-۰سروی کننده : لطفا به طور تصادفی یک طفل که سن اش

What is the sex of this child? این طفل چیست؟ جنسیت

Male مذکر Female مونث

2b) What is the age of this child in months? ___________ ؟این طفل چند ماهه است

2c) Has this child been ill in the past two weeks? آیا این طفل در دو هفته گذشته مریض شده؟

Yes بلی

No نخیر

Note: if 2c=no, skip to 3a

الف مراجعه کنید۳ اګر جواب نه خیر باشد به سوال

2d) What type of illness did this child have? Multiple responses are allowed.

این طفل چه مریضی داشت؟ )چندین جواب داده میتواند(

Fever

تب )درجه حرارت باال(

Coughing سرفه

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Diarrhea (any time that the child has 3 or more loose stools per day)

دفعه و یا زیادتر از آن مواد ۳اسهال )وقتیکه یک طفل در یک روز غایطه آبگین )اوگین( کند(

Other (specify) _____________________ )دیگر) مشخص سازید____________________________

2e) Did you ask for any advice outside of the home for the child’s illness?

آیا در باره مریضی این طفل در بیرون از خانه از کسی مشوره خواسته

اید؟

Yes بلی

No نخیر

>if 2e=no, skip to 2h

اچ مراجعه کنید ۲خیر باشد به سوال اگر جواب ن

2f) If yes, where? (Multiple responses are allowed.) اگر جواب بلی باشد، کجا؟ )چندین جواب داده

میتواند(

Government hospital شفا خانه دولتی

Government health centre مرکز صحی دولتی

Government health post پسته صحی دولتی

Mobile clinic کلینک سیار

Community health worker کارمند صحی جامعه

Private hospital clinic کلینیک شفاخانه شخصی

Pharmacy دواخانه

Shop دکان

Traditional healer محلیدوای

2g) How many days after the child got sick did you first try to find treatment for this child?

چند روز بعد از این که این طفل مریض شد شما برای عالجش کوشش کردید؟ برای اولین دفعه

Same day عین روز

Next day روز بعدی

2 or more days دو روز یا بیشتر

Don't know نمی دانم

2h) Sometimes children get sick and quickly needs treatment. What do you think are the signs of illness that your child needs urgent treatment? (multiple responses are allowed)

بعضی اوقات اطفال مریض می شوند و به سرعت به تداوی ضرورت دارند به نظر شما کدام عالمه های مریضی در نزد طفل

ضرورت به تداوی عاجل دارد؟

)چندین جواب داده میتواند(

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Looks unwell or not playing normally خوب معلوم نمیشود یا به صورت عادی بازی نمی کند

Not eating or drinking نمی نوشد یانمی خورد

Sleepy, lazy, difficult to wake خواب آلود است، تنبل است، به سختی بیدار میشود

High fever تب بلند

Cough, fast/difficult breathing تیز/ به مشکل تنفس میکند ،سرفه

Vomits everything میکند غهمه چیز را استفرا

Convulsions )اختالج ) حمله

Diarrhea with blood in stool خون دیده میشود شان اسهال است و در مواد غایطه

Stiff neck یگردن شخ

Other, specify: _____________________

دیگر مشخص کنید _____________________________________

Don't know نمی فهمم

3. Breastfeeding Practices روش تغذی با شیر مادر 3a) Do you have a child aged 0-23 months in your household?

ماهه در خانواده تان دارید؟ ۲۳الی ۰آیا یک طفل

Yes بلی

No نخیر

>if 3a = no, skip to 4a

اې مراجعه کنید ۴اګر جواب نه خیر باشد به سوال

3b) I’d like to ask you about the youngest child in your home who is less than 23 months. What is the

age of the youngest child in months?

ماهه است بپرسم؟ خوردترین طفل تان چند ماهه است؟ ۲۳میخواهم در باره خوردترین طفل تان که سن اش کمتر از

___________________

3c) What is the sex of the youngest child aged 0-23 months.

ماهه است دختر است یا بچه؟از صفر تا بیست و سه ماهه( ) ۲۳الی ۰خوردترین طفل شما که سن اش از

Male مذکر

Female مونث

3d) Has this child ever been breastfed? را خورده است؟ مادر آیا همین طفل گاهی شیر

Yes بلی

No خیرن

>if 3d=no, skip to 4a

اې مراجعه کنید ۴اګر جواب نی باشد به سوال

3e) How long after birth did you first put this child to the breast?

؟بعد از تولد طفل، شما چند مدت بعد طفل را برای بار اول شیر مادر شان را داده اید

Within one hour در جریان یک ساعت

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In the first day (within 24 hours) ساعت(۲۴ جریاندر روز اول)در

After the first day (more than 24 hours) ( ساعت(۲۴از بیشتربعد از روز اول

3f) Was this child breast fed yesterday during the day or at night?

مادر را خورده است؟ وز این طفل از طرف روز یا شب شیرآیا دیر

Yes بلی

No نخیر

Don’t Know نمی فهمم

>if 3f=yes, skip to 3h

اچ مراجعه کنید ۳باشد به سوال خیراګر جواب ن

3g) How many months did this child breastfeed before stopping?

؟این طفل تا چند ماهگی از شیر مادر تغذیه شده است

______________________

3h) Yesterday during the day and night, what drinks did you give the child other than breast milk?

دیروز در جریان روز و شب، به غیر از شیر مادر، دیگر کدام نوشیدنی ها را به طفل تان دادید؟

Only Breastmilk تنها شیر مادر

Infant formula شیر خشک

Animal milk, powder milk, yogurt ،ماستشیر گاو یا حیوان دیگر، شیر خشک

Cereal based diet (rice porridge, bread porridge) )غذای ساخته شده از غله ) فرنی برنج، فرنی نان

Plain water آب عادی

Fruit juice )آب میوه ) جوس

Sugar water آب بوره دار

Clear broth/soup شوربای ترکاری /سوپ

Other, specify: _____________________

__________________چیزی دیگر، واضح سازید

3i) What foods were given to this child yesterday during the day and night. This includes food given at

home AND outside the home? (Enumerator - Read out the list and check all that apply).

را برای این طفل دادید. این خوراکه ها شامل خوراک های می باشد که در خانه و ر جریان روز و شب کدام خوراکه هادیروز د

خارج از خانه به طفل داده شده است؟ ) سروی کننده : لیست را بخوانید و همه موارد مورد نظر را بررسی کنید.(

Breastmilk only تنها شیر مادر

Grains, roots, and tubers حبوبات، نباتات ریشه دار، ریشه های پیاز ماند مثل کچالو

Flesh foods (meat/fish/poultry/organ meats ) )غذاهای گوشتی )گوشت / ماهی / مرغ / جگر، تیلی، گرده

Legumes and Nuts (beans, peas, nuts) لوبیا، نخود، چارمغز(سبزی های دانه دار و مغزیات(

Dairy products (milk, yoghurt, cheese, powdered milk)

)لبنیات )شیر، ماست، پنیر، شیر خشک

Eggs تخم

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Vitamin A rich fruits & vegetables (pumpkin, carrot, apricot)

)کدو،زردک، Aمیوه ها و سبزی های که مقدار زیاد ویتامین

زردآلو(

Other fruits and vegetables (specify) میوها و سبزیجات دیگر واضح سازید

Nothing given to the child هیچ چیزی به طفل داده نشده است

Other, specify: _____________________

________________________________دیگر) مشخص سازید(

4. GAM/proxy MUAC اندازه گیری محیط بازو 4a) (Enumerator: Take MUAC measurement of all under five children (age 6-59 months) and

Pregnant/Lactating Women (PLW) in the household.)

ماه( ، خانم های باردار و شیرده در خانواده ۵۹الی ۶)کودکان سن سال سروی کننده: اندازه قطر بازوی تمام اطفال زیر سن پنج

را بگیرید.

Child Name نام طفل

MUAC measurement in cm متر سانتی به موک یا قطر بازوی طفل اندازه

Child 1 طفل اول

Child 2 طفل دوم

Child 3 طفل سوم

Child 4 طفل چهارم

4b) For each child: Is this child (NAME) currently enrolled in a nutrition programme?

آیا این طفل ) اسم طفل( در حال حاضر در کدام پروگرام تغذی شامل

است؟

Yes, Ration card seen بلی، کارت مواد غذایی دیده شد.

Yes, Ration card not seen بلی، کارت مواد غذایی

شد.دیده ن

If yes, with whom? ؟ چه کسیاگر جواب بلی باشد، با

No نخیر

Child 1 طفل اول

Child 2 طفل دوم

Child 3 طفل سوم

Child 4 طفل چهارم

4d) For each PLW: برای هر خانم باردار شیرده

MUAC measurement in CM اندازه قطر بازو به سانتی متر

PLW 1 اندازه قطر بازو به سانتی متر ۱شیرده و باردار خانم

PLW 2 اندازه قطر بازو به سانتی متر ۲شیرده و باردار خانم

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5. Water Quality کیفیت آب 5a) Where did you collect your drinking water from in the past day?

شما در جریان روز گذشته آب آشامیدنی خود را از کجا آورده

؟ اید

Tapstand نلآب

Protected spring شده ) چشمه های سر پوشیده( محافظت چشمه

Handpump well چاه بمبه دار

Unprotected open well نشده محافظتسرباز چاه

Unprotected spring نشده محافظت یاچشمه سرباز

River / pond حوضچه/دریا

Water cart آب کراچی

Tanker-truck تانکر آب

Other (specify) )دیگر) مشخص سازید

5b) How many minutes does it take to travel to the water source, collect water and return?

برای گرفتن آب به آنجا رفته، آب تان راگرفته دوباره برمیگردیدچند دقیقه وقت تانرا میگیرد که

Less than 15 minutes دقیقه ۱۵کمتر از

15 – 30 minutes

۳۰ - ۱۵دقیقه

30 – 60 minutes ۶۰ -۳۰دقیقه

1 – 2 hours ۲-۱ساعت

More than 2 hours ساعت ۲زیادتر از

5c) Can you show me where you store drinking water in the house? (Enumerator - Based on your

observation, select the following conditions that apply:

آیا می توانید به من نشان دهید که آب خوردن تان را در خانه درکجا ذخیره می کنید؟

ا که با آن مطابقت می کند انتخاب سروی کننده: بر اساس مشاهدات خود، شرایط زیر ر

کنید:

the water storage containers are clean ظروف ذخیره آب پاک است the water storage containers have lids (are covered )

ظروف ذخیره آب سر پوش دار هستند ) سرپوشیده هستند(

the water storage containers are not clean and are not covered

ظروف ذخیره آب پاک و سرپوشیده نیستند

No water storage container available ظروف ذخیره آب موجود نیست

27

6. Water Quantity مقدار آب 6a) How many containers of water were collected for your household yesterday (in litres)?

خانواده شما دیروز چند بشکه آب را آوردند یا ذخیره کردند )به لیتر(؟

6.a.1) How many 5 litre containers (small jugs) of water were collected for your household yesterday?

لیتره ) بشکه های خورد( آب برای خانواده تان آورده شده بود؟ ۵دیروز چند بشکه

_____________________________

6.a.2) How many 10 litre containers (buckets) of water were collected for your household yesterday?

لیتره ) سطل( آب برای خانواده تان آورده شده بود؟ ۱۰دیروز چند بشکه

_____________________________

6.a.3) How many 20 litre containers (jerry cans) of water were collected for your household yesterday?

لیتره آب برای خانواده شما آورده شده ۲۰دیروز چند بشکه

بود؟

_____________________________

6.a.4) If other, of other containers of volume (include: container, liter per container, total liters)

لیتر هر ذخیره، و اندازه مجموعی یا لیتر تعدادبشکه، نوعیتاگر از ذخیره هاویاهم بشکه های با حجم های دیگر استفاده می کنید )

مجموعی را بنویسید(

_____________________________

6b) How much of this water that was collected yesterday was used for cooking, cleaning, washing,

drinking and eating (in litres)?

از مقدار آبیکه دیروز برایتان آورده شده بود چقدر آنرا را برای پخت وپز ، پاک کاری، کاال شویی و خوردن استفاده کردید )به لیتر(؟

_____________________________

7. Sanitation Facilities سهولت های حفظ الصحه 7a) Where do people in the household go to the toilet (defecate) most of the time? Can you show me

this place?

اعضای خانواده ای تان اکثر اوقات در کجا رفع حاجت می کنند؟ می توانید آن را برای ما نشان بدهید؟

Improved latrine (ventilated, with slab, pit or sealed vault, walls present)

، سوراخ سر سلب یا سرپوش دارکناراب اصالح شده )هواکش دار،

پوشیده ، دارای چار دیواری(

Unimproved latrine (pit or vault is not sealed, no ventilation pipe)

شده )سوراخ سر باز، هوا کش ندارد(کناراب اصالح نا

Basic latrine (shallow vault or pit, lacking walls or roof)

کناراب عادی )سوراخ کناراب زیاد چقر نیست، چت و چار دیواری

ندارد(

Open defecation رفع حاجت در بیرون در جاهای سر باز

Dig and bury را دفن می کنندزمین را چقر کرده مواد

Other (specify) ____________________ )دیگر) واضح سازید_______________________

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8. Handwashing Practices شیوه های شستشوی دست ها8a) In the past 24 hours, when did you wash your hands with soap? (Enumerator: Check all that apply,

do not prompt)

ساعت گذشته، چه وقت دست های تان را با صابون شستید؟ ) سروی کننده: همه موارد را بررسی کنید عجله نکنید( ۲۴در

After defecation بعد از رفع حاجت

After cleaning a child's defecation بعد از پاک کردن کردن مواد غایطه اطفال

Before cooking پیش از دیگ پختن

Before eating پیش از نان خوردن

Before breastfeeding or feeding a child پیش از شیر دادن یا نان دادن به طفل

After caring for animals بعد از مراقبت از حیوانات

When hands are visibly dirty شوندوقتکه دستها به صورت واضح نا پاک معلوم می

Other (specify) ____________________ )دیگر) واضح سازید_______________________

8b) Can you list the times in the day when it is most important to wash your hands? (Enumerator:

Check all that apply, do not prompt)

؟ ) سروی کننده: همه موارد را که مطابقت می کند بررسی کنید، روزکدام وقتها دست های تان را میشویدآیا میتوانید بگوید که در یک

عجله نه کنید(

After defecation بعد از رفع حاجت

After cleaning a child's defecation بعد از پاک کردن کردن مواد غایطه اطفال

Before cooking پیش از دیگ پختن

Before eating پیش از نان خوردن

Before breastfeeding or feeding a child پیش از شیر دادن یا نان دادن به طفل

After caring for animals بعد از مراقبت از حیوانات

When hands are visibly dirty وقتکه دستها به صورت واضح نا پاک معلوم می شوند

Other (specify) ____________________ )دیگر) واضح سازید_______________________

8c) Can you show me where you wash your hands? (Enumerator: Based on your observation, select

the following conditions that apply)

ما نشانداده میتوانید؟ ) سروی کننده: بر اساس مشاهدات خود، شرایط زیر را که قابل آیا جایی را که دست های تانرا در آن میشویید به

تطبیق است انتخاب کنید(

Yes, there is a washing facility (dedicated jug) with soap and water present

بلی ، یک وسیله شستشو )افتاوه مخصوص( با آب و صابون وجود

دارد

Partial, there is a washing facility (dedicated jug) with only water available

، یک وسیله شستشو )افتاوه مخصوص( تنها با آب تایک اندازه

موجود است

No, there is no specific place or container نه، جای یا ظرف خاصی با آب و صابون وجود ندارد

29

with water or soap present

Not Observed دیده نشد

9. Household Dietary Diversity تنوع غذایی خانواده 9a) In this year, did you grow any fruit or vegetables near your home for eating?

اید کشت کردهآیا امسال شما در نزدیکی خانه تان سبزی یا میوه برای خوردن تان

؟

Yes بلی

No نخیر

9b) In the past 7 days, which of the following foods did your household members eat?

روز گذشته، کدام یک از غذاهای زیر را اعضای خانواده تان خورده اند؟ ) سروی کننده: لیست غذا ها را بخوانید( ۷در

How many days were these foods eaten in the last 7 days?

این غذا راخورده چند روزروز ګذشته ۷درجریان

اید؟

Foods

غذا ها

# of days eaten

که های روز تعدادکرده استفاده

Cereal: bread, rice, noodles, porridge )غله جات: )نان، برنج، فرنی،آش White roots (potatoes) )ریشه سفید )کچالو Dairy products (milk, yogurt) )لبنیات )شیر، ماست Meat گوشت Fish گوشت ماهی Eggs تخم

Yellow/orange vegetables (pumpkin, carrot)

سبزیجات زرد / نارنجی )کدو، زردک(

Dark green leafy vegetables (spinach, cabbage)

سبزیجات دارای برگ سبز تیره )پالک، کرم(

Other vegetables (tomato, onion, eggplant)

سبزیجات دیگر )بادنجان رومی، پیاز، بادنجان سیاه(

Apricot (fresh or dried) )زردآلو) تازه یا خشک Other fruit (apple, melon) )میوه جات دیگر)سیب، خربوزه

Nuts or legumes (walnuts, peas, beans)

حبوبات )چهار مغز، نخود، لوبیا(مغزیات یا

Fat (oil, butter) )چربی)روغن، مسکه Sugar (honey, sugar, candies) )بوره )عسل،بوره، شیرنی Tea چای

Other (specify)____________________

دیگر) واضح سازید(

________________________________

__

10. Household Hunger Scale میزان گرسنگی خانوادهEnumerator Instruction: Tell the respondent that the next series of questions will ask you to think back

over the past 4 weeks (1 month)

30

ماه( ۱که در باره چهار هفته گذشته )رهنمای سروی کننده: به جواب دهندگان بگویید که در سواالت بعدی از شما تقاضا خواهد شده

فکر کنید

10a) In the past four weeks, was there ever no food to eat of any kind in your household because of a

lack of resources to get food?

تان بی نان ) بی غذا( بوده در طول چهار هفته گذشته، به خاطر کمبود منابع برای تهیه غذا، آیا گاهی خانواده

است؟

Yes بلی

No نخیر

10xx) If yes, how often did this happen? اگر بله، چند بار اتفاق افتاد ) یعنی چند بار بدون غذا بودید(؟

Rarely (1-2 times in the past month) ( دفعه در ماه گذشته( ۲-۱بسیار کم

Sometimes (3-10 times in past month) ( بار در ماه گذشته( ۱۰تا ۳بعضی اوقات

Often (more than 10 times in past month) بار در ماه گذشته( ۱۰ګاهی ګاهی )بیش از

10b) In the past four weeks, did you or any household member go to sleep at night hungry because

there was not enough food?

در چهار هفته گذشته، شما یا کدام عضو خانواده شما به خاطر نداشتن غذای کافی شب گشنه خواب شده

اید؟

Yes بلی

No نخیر

10xx) If yes, how often did this happen? اگر بله، چند بار اتفاق افتاد ) یعنی چند بار گشنه خواب شده

اید(؟

Rarely (1-2 times in the past month) ( دفعه در ماه گذشته( ۲-۱بسیار کم

Sometimes (3-10 times in past month) ( بار در ماه گذشته( ۱۰تا ۳بعضی اوقات

Often (more than 10 times in past month) بار در ماه گذشته( ۱۰ګاهی ګاهی )بیش از

10c) In the past four weeks, did you or any household member go a whole day and night without eating

anything because there was not enough food?

سپری در طول چهار هفته گذشته شما یا کدام عضو خانواده شما به خاطر نداشتن غذای کافی یک شب و روز را بدون غذا خوردن

اید؟ کرده

Yes بلی

No نخیر

10xx) If yes, how often did this happen? اید(؟ سپری کردهرا بدون غذا شبانروز یک در اگر بله، چند بار اتفاق افتاد ) یعنی چند بار

Rarely (1-2 times in the past month) ( دفعه در ماه گذشته( ۲-۱بسیار کم

Sometimes (3-10 times in past month) ( بار در ماه گذشته( ۱۰تا ۳بعضی اوقات

31

Often (more than 10 times in past month) بار در ماه گذشته( ۱۰ګاهی ګاهی )بیش از

11. Coping Strategies ستراتیژی توافق

11a) During the past 7 days, has anyone in your household done any of these things? (Please tell me the

number of days that you…..)

روز گذشته، آیا کسی از اعضای خانواده ی شما کار های ذیل را انجام داده اند؟ )لطفا تعداد روزهای را که شما........ ۷در جریان

بگویید (

Relied on less preferred food and less expensive food

اتکا باالی غذای که کم خوش دارید و ارزان باشد

Borrowed food, or rely on help from friends and relatives

،اقارب و دوستان کمک باالی اتکا یا غذای قرض

Restricted consumption by adults in order for small children to eat

برای اطفال تا بزرگساالن، برای غذا صرفم کردن محدود

باشند داشته غذا خوردن

Limited portion size at mealtimes مقدار محدود غذا در وقت های غذا

Reduced the number of meals eaten in a day تعداد کم دفعات غذا خوردن روزانه ) به جای سه وقت غذا

خوردن دو یا یک وقت غذا خوردن(Sent children to work for money outside the home

از خانه روان کردنبرای به دست آورن پول به بیرون را اطفال

11b) Have all family members been affected by the above coping strategies?

آیا همه اعضای خانواده از ستراتیژی توافق که در باال ذکر شده متأثر شده بودند؟

Yes بلی

No نخیر

Which family members have been more affected?

اعضای خانواده از این ستراتیژی زیادتر متأثر شده بودند؟کدام یک از

Women ☐ Yes بلی ☐ No زنان نخیر

Men ☐ Yes بلی ☐ No مردان نخیر

Children ☐ Yes بلی ☐ No اطفال نخیر

12. Beneficiary Feedback فیدبک مستفید

شوندگان

12a) How would you prefer to give good or bad feedback to aid agencies about the assistance you are receiving? Note: multiple responses are allowed.

چگونه میخواهید نظرات )مثبت یا منفی( خود را به سازمانهای کمک کننده درباره کمک های که به شما میکند ارائه نماید؟

ل اجرا استجواب های مختلف قاب

Face to face (at home) with aid worker رو برو)در خانه( با کار مند کمک کننده

Face to face (office/other venue) with aid رو برو )در دفتر / محل دیگر( با کارمند کمک کننده

32

worker

Face to face with member of the community رو برو با عضو محل

Phone call تماس تیلفونی

SMS پیام

Email ایمیل

Letter نامه

Complaints/Suggestions box صندوق شکایات/پیشنهادات

Other (specify) ____________________ )دیگر) واضح سازید_______________________

12b) How would you prefer to give feedback to aid agencies about any bad behavior or misconduct of aid workers? Multiple responses are allowed.

به سازمان های کمک کننده در مورد رفتار بد یا خالف کاری کارمندان کمک کننده چگونه میخواهید نظر بدهید ؟

ای مختلف قابل اجرا استجواب ه

Face to face (at home) with aid worker رو برو)در خانه( با کار مند کمک کننده

Face to face (office/other venue) with aid worker

رو برو )در دفتر / محل دیگر( با کارمند کمک کننده

Face to face with member of the community عضو محل رو برو با

Phone call تماس تیلفونی

SMS پیام

Email ایمیل

Letter نامه

Complaints/Suggestions box صندوق شکایات/پیشنهادات

Other (specify) ____________________ )دیگر) واضح سازید_______________________

End of survey پایان سروی This is the end of our survey. We want to thank you very much for giving us your time and the information.

می یاین پایان سروی ما است، از اینکه برای ما وقت دادید و معلومات تان را با ما شریک کردید از شما بسیار زیاد تشکر

کنیم